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General NPI Number Information
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NPI Number | 1578042727
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Entity Type | Individual
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Provider Name | DYKSTRA FREEMAN NP
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Gender | Male
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 817-702-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 PRESTON OAKS RD APT 1086
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City | DALLAS
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State | TX
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Zip | 75254-8709
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Country | US
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Telephone | 337-305-1602
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP138419
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License Number State | TX
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